title: Efficacy and safety of metallic stents in patients with unresectable pancreatic cancer receiving gemcitabine.
abstract: OBJECTIVE
  Expandable metallic stents (EMSs) are widely used to palliate unresectable malignant biliary obstructions. The efficacy and safety of EMS in patients receiving gemcitabine (GEM) for unresectable pancreatic cancer is evaluated.
  
  
  METHODS
  Data for 147 patients with unresectable pancreatic cancer were studied retrospectively: 52 received GEM without EMS, 36 received GEM with EMS, 27 received only best supportive care (BSC) without EMS, and 32 received BSC with EMS.
  
  
  RESULTS
  Expandable metallic stent did not increase adverse effects (>grade 2) caused by GEM (P = 0.809), and the rates of infections other than cholangitis and cholecystitis were neither increased by GEM nor by EMS (P = 0.287). Cholangitis and cholecystitis occurred exclusively in patients with EMS and was managed successfully. Tumor extension, good performance status, and GEM, but not EMS, were shown to affect survival. Stent-related complications were observed in 26 patients (72%) receiving GEM and in 17 patients (53%) with BSC (P = 0.133). Multivariate analyses revealed no predictors for stent-related complications, although the use of covered EMS and good performance status were associated with longer stent patency. Gemcitabine affected neither stent-related complications nor stent patency.
  
  
  CONCLUSIONS
  Expandable metallic stent placement is safe and effective in patients with unresectable pancreatic cancer receiving GEM. Gemcitabine improves survival irrespective of EMS placement.
authors.affiliation: Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan. ynakai-tky@umin.ac.jp
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Arizumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagioka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Saburou
authors.initials: S
authors.lastname: Matsubara
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D002761:Cholangitis / Q000209:etiology; D002764:Cholecystitis / Q000209:etiology; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D008670:Metals; D003841:Deoxycytidine; D000093542:Gemcitabine